Uchenna R Ofoma1, Anne M Drewry2, Thomas M Maddox3, Walter Boyle2, Elena Deych4, Marin Kollef5, Saket Girotra6, Karen E Joynt Maddox4. 1. Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA. Electronic address: uofoma@wustl.edu. 2. Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA. 3. Division of Cardiology, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA; Healthcare Innovation Laboratory, BJC Healthcare and Washington University School of Medicine, St. Louis, MO, USA. 4. Division of Cardiology, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA. 5. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA. 6. Division of Cardiovascular Diseases, Department of Medicine, University of Iowa Hospitals and Clinics and the Iowa City Veterans Affairs Medical Center, Iowa City, IA, USA.
Abstract
BACKGROUND: Survival rates following in-hospital cardiac arrest (IHCA) are lower during nights and weekends (off-hours), as compared to daytime on weekdays (on-hours). Telemedicine Critical Care (TCC) may provide clinical support to improve IHCA outcomes, particularly during off-hours. OBJECTIVE: To evaluate the association between hospital availability of TCC and IHCA survival. METHODS: We identified 44,585 adults at 280 U.S. hospitals in the Get With The Guidelines® - Resuscitation registry who suffered IHCA in an Intensive Care Unit (ICU) or hospital ward between July 2017 and December 2019. We used 2-level hierarchical multivariable logistic regression to investigate whether TCC availability was associated with better survival, overall, and during on-hours (Monday-Friday 7:00 a.m.-10:59p.m.) vs. off-hours (Monday-Friday 11:00p.m.-6:59 a.m., and Saturday-Sunday, all day, and US national holidays). RESULTS: 14,373 (32.2%) participants suffered IHCA at hospitals with TCC, and 27,032 (60.6%) occurred in an ICU. There was no difference between TCC and non-TCC hospitals in acute resuscitation survival rate or survival to discharge rates for either IHCA occurring in the ICU (acute survival odds ratio [OR] 1.02, 95% CI 0.92-1.15; survival to discharge OR 0.94 [0.83-1.07]) or outside of the ICU (acute survival OR 1.03 [0.91-1.17]; survival to discharge OR 0.99 [0.86-1.12]. Timing of cardiac arrest did not modify the association between TCC availability and acute resuscitation survival (P =.37 for interaction) or survival to discharge (P =.39 for interaction). CONCLUSIONS: Hospital availability of TCC was not associated with improved outcomes for in-hospital cardiac arrest.
BACKGROUND: Survival rates following in-hospital cardiac arrest (IHCA) are lower during nights and weekends (off-hours), as compared to daytime on weekdays (on-hours). Telemedicine Critical Care (TCC) may provide clinical support to improve IHCA outcomes, particularly during off-hours. OBJECTIVE: To evaluate the association between hospital availability of TCC and IHCA survival. METHODS: We identified 44,585 adults at 280 U.S. hospitals in the Get With The Guidelines® - Resuscitation registry who suffered IHCA in an Intensive Care Unit (ICU) or hospital ward between July 2017 and December 2019. We used 2-level hierarchical multivariable logistic regression to investigate whether TCC availability was associated with better survival, overall, and during on-hours (Monday-Friday 7:00 a.m.-10:59p.m.) vs. off-hours (Monday-Friday 11:00p.m.-6:59 a.m., and Saturday-Sunday, all day, and US national holidays). RESULTS: 14,373 (32.2%) participants suffered IHCA at hospitals with TCC, and 27,032 (60.6%) occurred in an ICU. There was no difference between TCC and non-TCC hospitals in acute resuscitation survival rate or survival to discharge rates for either IHCA occurring in the ICU (acute survival odds ratio [OR] 1.02, 95% CI 0.92-1.15; survival to discharge OR 0.94 [0.83-1.07]) or outside of the ICU (acute survival OR 1.03 [0.91-1.17]; survival to discharge OR 0.99 [0.86-1.12]. Timing of cardiac arrest did not modify the association between TCC availability and acute resuscitation survival (P =.37 for interaction) or survival to discharge (P =.39 for interaction). CONCLUSIONS: Hospital availability of TCC was not associated with improved outcomes for in-hospital cardiac arrest.
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